Fewer S.C. women choosing to induce early birth

Columbia — Fewer pregnant women in South Carolina are choosing to give birth ahead of a full term by having an unwarranted, early-elective induction.

Fifty percent fewer, according to a case study released Thursday about the South Carolina Birth Outcomes Initiative, an effort between various organizations.

The achievement has reduced neonatal intensive care unit admissions and saved the state Department of Health and Human Services more than $6 million in the first quarter of 2013, according to a press release from the agency.

The nonprofit Catalyst for Payment Reform authored the study with support from the Milbank Fund to review the initiative, including the role of payment reform and what others could gather from South Carolina’s experience.

“Early-term” describes any birth as before 37 and 38 weeks. The American College of Obstetricians and Gynecologists issued an opinion clarifying a “term pregnancy” as 39 weeks and beyond.

He said the results equate to fewer babies staying in the neonatal intensive care unit.

Early deliveries performed for non-medical reasons are typically done for the convenience of either or both the patient and provider, as a way to relieve the pregnant woman’s discomfort, and the provider’s perceived liability concerns.

“Providers can feel pressure from patients who are hoping to deliver in a certain time period,” states the study.

Other states have pursued voluntary efforts to cut back on the number of early-elective deliveries, and some state Medicaid agencies have stopped paying the procedures.

But South Carolina is the first in which the Medicaid agency and the largest commercial insurers have joined together to create a policy of not paying for the service. Together, BlueCross BlueShield South Carolina and Healthy Connections Medicaid pay for 85 percent of births in the Palmetto state, according to Keck’s agency.

“That it has already garnered national attention and is being used as a model for other states to follow in tackling two of nation’s greatest health problems – infant mortality and low birth weight babies – is telling of the success of the program,” said obstetrician Amy Picklesimer, who acts as the initiative’s clinical lead.

About 10-15 percent of babies in the U.S. are believed to be delivered early for no medical reason, according to a report by the U.S. Department of Health and Human Services last year.

In 2011, South Carolina had the fourth highest percentage of babies born prematurely, with a rate of early-elective delivery of 9.62 percent — or at least 6,000 births — much higher than a recommended 5 percent maximum.

In September of that year, through the Birth Outcomes Initiative and S.C. Hospital Association, all of South Carolina’s 43 birthing hospitals signed a pledge to stop early elective deliveries.